Oxford Handbook of General Practice 4th Edition


Oxford Handbook of General Practice 4th Edition

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Oxford Handbook of General Practice 4th Edition What is general practice?
‘Generalism describes a philosophy of practice which is person, not disease,
centred; continuous, not episodic; integrates biotechnical and biographical perspectives; and views health as a resource for living and not an end in itself.’ 1 In the early 19th century, when apothecaries, physicians, and surgeons provided  medical care, the term ‘general practitioner’ became applied to apothecaries taking the Membership Examination of the Royal College of Surgeons of England.

Over the past 60y, general practice has established itself as the corner-
stone of most national healthcare systems. In so doing, general practi-
tioners (GPs or family physicians) have shown the intellectual framework
within which they operate is different from, complementary to, but no less
demanding than that of specialists.
What is medical generalism? The RCGP defines medical generalism
as: ‘An approach to the delivery of healthcare that routinely applies a
broad and holistic perspective to the patient’s problems.’ It involves:
• Seeing the person as a whole and in the context of his/her family and
wider social environment
• Using this perspective as part of the clinical method and therapeutic
approach to all clinical encounters
• Being able to deal with undifferentiated illness and the widest range of
patients and conditions
• In the context of general practice, taking continuity of responsibility for
people’s care across many disease episodes and over time

• Also in general practice, coordinating care as needed across  organizations within and between health and social care The role of the GP In the UK, >90% of the population is registered
with a GP. GPs diagnose illness, treat minor illness within the community,
promote better health, prevent disease, certify disease, monitor chronic
disease, and refer patients requiring specialist services. General practice is
the primary point of access to healthcare services.

Although patients have an average of 5.5 consultations with their GP every
year in the UK, only 1 in 20 consultations results in a secondary care referral.
Everything else is dealt with in the primary care setting. To do this, GPs must:

• Have a working knowledge of the whole breadth of medicine
• Maintain ongoing relationships with their patients—they are the only
doctors to remain with their patients through sickness and health
• Focus on patients’ response to illness rather than the illness itself,
taking into account personality, family patterns, and the effect of these
on the presentation of symptoms
• Be interested in the ecology of health and illness within communities
and in the cultural determinants of health beliefs, and
• Be able to draw on a far wider range of resources than are taught
in medical school, including intuition, knowledge of medicine,
communication skills, business skills, and humanity

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Oxford Handbook of General Practice 4th Edition